Provider Demographics
NPI:1457342594
Name:PROSCAN IMAGING OF CHILLICOTHE, LLC
Entity Type:Organization
Organization Name:PROSCAN IMAGING OF CHILLICOTHE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:N
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-281-3400
Mailing Address - Street 1:1200 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1845
Mailing Address - Country:US
Mailing Address - Phone:740-775-7226
Mailing Address - Fax:740-773-7226
Practice Address - Street 1:1200 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1845
Practice Address - Country:US
Practice Address - Phone:740-775-7226
Practice Address - Fax:740-773-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1118IC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00203268OtherRAILROAD MEDICARE
OH2558870Medicaid
OH000000342976OtherANTHEM PIN
OH000000342976OtherANTHEM PIN